Provider Demographics
NPI:1033690664
Name:JADHAV, SANJANA
Entity Type:Individual
Prefix:MS
First Name:SANJANA
Middle Name:
Last Name:JADHAV
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SANJANA
Other - Middle Name:SHREEKUMAR
Other - Last Name:NAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5413 RIVERSIDE STATION BLVD
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-4454
Mailing Address - Country:US
Mailing Address - Phone:716-435-6850
Mailing Address - Fax:
Practice Address - Street 1:401 E 34TH ST APT N5N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6604
Practice Address - Country:US
Practice Address - Phone:716-435-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist